ArcaMax

Hello Toni:

I have Original Medicare with a Supplement. In March, I was ambulanced to the emergency room for heart issues. I had a big surprise when a hospital employee asked me to sign a Medicare form while I was waiting in the ER to see if I was to be admitted as an inpatient or sent home. I was lucky that the doctor sent me home.

Did I do the right thing to sign the Medicare form while waiting? My sister said that I should contact you because she did not have to do this when she had cataract surgery last summer. Looking forward to what you have to say about being admitted into the hospital from the ER. Thank you, Toni.

-- Sandra from Sugar Land, Texas

Hi Sandra:

Your hospital situation was different from your sister’s because she was having out-patient surgery, and you were in the emergency room due to a health issue. “Original” Medicare -- not Medicare Advantage (MA) plans -- has two different situations when one is asked to sign a Medicare form.

The first circumstance is Medicare’s Outpatient Observation Notice rule. It only affects those who are enrolled in “Original Medicare” with or without a Medicare Supplement. The second is Medicare’s “Lifetime Reserve Days,” which gives someone on Medicare 365 days in a hospital stay “extra” only when one has a Medicare Supplement, such as what you are enrolled in, Sandra. Remember that the two Medicare rules ONLY affect those enrolled in original Medicare, not an MA plan.

1. Medicare Outpatient Observation Notice (MOON) is available for those enrolled in original Medicare with or without a Medicare Supplement. This Medicare rule began a few years ago. Page 28 of the 2025 Medicare & You handbook completely explains this rule under “Am I an inpatient or outpatient?” It states, “Each day you have to stay, you or your caregiver should ask the hospital and/or your doctor, a hospital social worker, or a patient advocate if you’re an inpatient or outpatient.” Know whether you are an “inpatient or outpatient,” because it affects what is covered in the hospital.

2. Lifetime Reserve Days are explained on page 27 of the handbook. For 2025, Medicare Part A covers an inpatient hospital stay with a $1,676 deductible for days 1- 60, 6 times a year. For days 61 through 90, Medicare pays all but $419; days 91 and thereafter, Medicare pays all but $838 with the 60 “Lifetime Reserve Days” to be used. Once the lifetime reserve days are used, then the “inpatient hospital benefits” are exhausted and you will pay all the cost.

Sandra, you have a Medicare Supplement Plan G, and your Part A-Inpatient Hospital costs are paid for by the plan with an “extra” 365 days of inpatient hospital coverage that only a Medicare Supplement will pay for. During the “extra” 365 days, the hospital is forbidden to bill you for the balance. It must bill the Medicare Supplement, and the hospital must sign-off on specific Medicare/hospital forms.

There is a notice written in the summary of benefits of Medicare Supplement policies that states, “NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid up to an additional 365 days as provided in the policy's ‘Core Benefits.’ During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.”

This is good news for you, Sandra. Because you have a Medicare Supplement, you will have an additional 365 days of “inpatient hospital benefits” that only a Medicare Supplement insurance plan will pay. If you do end up in the hospital for a long time, you will luckily pay $0 for the “additional 365 days.”

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Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. The “Medicare Survival Guide Advanced” edition and her new “Confused about Medicare” video series are available at www.tonisays.com.s

Copyright 2025 Toni King, Distributed by Counterpoint Media